A Pain in the Neck

Ever since my meltdown about not wanting to take weeks of antibiotics for the embolization-induced blood infection, I feel like the doctors and nurses have been trying to lure me back from the ledge, into a room piled high with antibiotics.

Right now, I am on two types of antibiotics: an IV drip twice a day and two rounds of Doxycycline.  I am still up because my guts are roiling and my intestines feel like a burning cauldron. The overnight intern stopped by to tell me I was getting more fluids, because my low blood pressure is making people nervous. There is nothing anyone can do. I have to be on antibiotics to knock out the infection and the antibiotics make me really sick. There is only one choice, and it is an unpleasant one.

Thankfully, as of right now at least, I am slated to take the IV antibiotics only through Saturday, then I just graduate to one. I don’t know that I’ll feel much better, but one seems like it might make me less sick than two. The bad news is that they want me to take two weeks of oral antibiotics after I’m done with the IV antibiotics. I understood yesterday that the two weeks started yesterday but they mean it starts Sunday. The date on my calendar is August 24. Nineteen days. I still don’t know if all of this illness is from the antibiotics but considering antibiotics landed me in the hospital for days last fall, it stands to reason that they’re not helping. Also, 19 days is a long time to stay out of the hospital in my current state.

Then there’s the worry that the treatment didn’t work. What if it didn’t work and I don’t know? I won’t know until late August.

I suppose that keeps me up at night too. (Also, I think my room thermostat problem is back and I am freezing and have a sore throat. I have just been tucked into some more warm blankets. I would like to be rolled up and tucked into the blanket warmer itself.)

Meanwhile, I felt as if my possible well-time from the PRRT is being stolen, hour by hour, moment by moment, by the antibiotics.

Today my oncologist stopped by and gave me a pep talk. She said we didn’t need this infection from the liver to happen, but sometimes it takes awhile for PRRT to kick in anyway. She says we should knock out this infection now so we don’t have to deal with it later. I agree that it would be silly to put in all this work and feel so terrible for three weeks and then skip the last week because I’m just so tired of antibiotics and feeling like crap and then risk starting back at square one.

I’ve been trying to rally but I’ve felt bad since late May and really awful since late June. I suppose one more week of feeling terrible isn’t going to make much difference at this point if I have some hope of coming out on the other side feeling better.

She understands how frustrated I am. We raced to this finish line with the PRRT and then I immediately ran into a brick wall with this infection.

But this isn’t necessarily my last hurrah. I could potentially receive more treatments in the future to extend my life and its quality. That’s huge news. If I can muster up the patience to get through these next three weeks of crap, then I can maybe look forward to even some more time. And even if I don’t have much more time beyond this, I need to stop looking at this as it’s stealing one-half of my good well time, because there’s absolutely nothing I can do at this point that doesn’t involve three more weeks of antibiotics and illness. Another CT scan was done today to see if anything has happened or if there’s a superinfection of some sort. I’m expecting bad news because it’s always bad news.

For now, I was given a little bit of hope, and that is always more powerful than self-pity and despair.

What do you do at the very end when it’s time to wrap up your life, even if it’s a tiny little life like mine? It’s a question I’ve been grappling with ever since I found out I had about a year a little over a year ago.  I think, for the most part, I did OK on the big-picture issues.

This latest PRRT treatment either hasn’t worked for me or is being derailed by a blood infection caused by my liver embolization or somewhere else in the bloodstream. I still don’t feel well. I want, more than anything, just a few more months of wellness.

Today I got the news that they want me on IV antibiotics at home for at least 10 more days. This is a compromise. They would rather have me do 14 days followed by weeks of oral antibiotics. But when I have only a few months of wellness, I can’t afford more days given over to nausea and dehydration. This means I have a needle sticking out of my chest at all times. This means daily IVs at home and a return to the life I have been avoiding.

I don’t even know if the PRRT worked or if I ever had a chance at all. The embolization infection is eating up all my time. I had hoped for just a few months of normalcy and today I realized I won’t have that anymore. All this waiting since May for some hope of good news feels as if it has been for nothing.

I can’t stop thinking that if I hadn’t gotten this embolization, I would be out celebrating in the sunshine right now instead of waiting to die in this hospital room. I did a few preliminary searches on embolization risks, but since I’d had it before, I thought it couldn’t hurt. I want to be out celebrating, not debating whether or not a needle painfully sticking out of my chest for another week will buy me a few better weeks later on.

I have practical matters ahead of me. Hospitals and credit card companies want to be paid. I need to wrap up passwords and close accounts.

I have to find a home for my three cats.

I have to forgive people who aren’t sorry. I have to let go of the grudges that have become so much a part of me that I feel like they’re driftwood, keeping me afloat. Instead, it’s time to extract some hard-won lessons from them and move forward, unfettered.

Still, I find myself unable to stop making regular run-of-the-mill plans. I want to see movies and go to concerts and eat things.

I have to stop that illusion now. There are a few things I might be able to do.

I have a freelance story I agreed to write while I thought I would be recovering from the PRRT, before I quit freelancing and devoted my main months to fun.

I feel guilty about the people who are seeing me through this in a deeply personal way. I can’t borrow them for too long. I need to return them to the land of the living before death touches them too much.

I feel like I’ve spent the whole year saying goodbye but it hasn’t been enough time. It will never be enough.

Since the blood infection took over on Wednesday, I have been grappling with what to do. I know now that I can’t go back to the illness and the constant IVs. If the infection doesn’t clear, then I know what I am going to do. I’m going to stop the electrolytes, the antibiotics, all the little things and adjustments they have made to keep me going for so long, the tiny things that keep my tiny life going. Then I’ll finally say to this body, the one that’s been trying so hard to die for so many years, “OK, it’s time.” And we’ll finally be in agreement and done.

I’m tired. I thought I had a few more months of fight left in me, but as it turns out, I don’t. I felt myself give up this morning. The ads I had for the vacations I was looking up yesterday mock me as places for the living, not the dying. The topics that come up in my social media feed make me sad. I want to live long enough to get more fine lines and tiny wrinkles. I want free shipping on home furnishings.

Instead, it’s time to pack up my tiny little life and go.

Yesterday, I got some disappointing news so I immediately tried to alienate people who care about me and would try to help. I pouted and wallowed in my self-pity and had internal tantrums until I quickly and finally became tired of myself.

The people temporarily humored my entreaties to be alone and then stepped back in once I asked them back, apologetic and sheepish. I knew what I was doing at the time, but I couldn’t stop myself. In some cases, I knew I couldn’t trust myself from the outset: I told my mom I loved her and I would talk to her today. I couldn’t talk yesterday. I honestly don’t know that I can talk to her right now.

Yesterday seemed initially kind of victorious. The PRRT appears to be working. However, the blood infection from the embolization necessitates IV antibiotics and the side effects negate any good the Lutathera has done, so it’s essentially as if nothing has happened. I’m on a pain pump that makes me exhausted and I feel sick to my stomach all the time. I’m dehydrated and pumped full of electrolytes and fluids and the hateful antibiotics that make my guts roil.

The doctors say that I have two types of bacteria in my blood. They are slowly clearing, but the protocol is two weeks of antibiotics. That’s two more weeks of misery. I thought and hoped they could cut it down from there and remained hopeful. Then the infectious disease doctor arrived at the end of the day: Two weeks is the minimum I would be on these antibiotics. Since treatment gives me probably only a few months of relief, that means that at least one-fourth of my time is being taken back by the antibiotics. This is sad and devastating to me. The embolization set me back, essentially, to square one.

The infectious disease doctor said he would think about what to do. I believe him. My medical team here also is thinking. Everyone is thinking. I’m mostly feeling sorry for myself. I’m so tired. I honestly don’t know if I have enough fight in me to make it through two more weeks of weakness just for a month of feeling OK. I’ve been struggling to hold on since late May—just a few more weeks for a scan, a few days for tests, weeks for insurance approval, a week for treatment. I felt good for one hour and then it was gone.

Two more weeks or a month for the equivalent on the other side to wait for this smug infection to settle sometimes seems pointless. At other times, it seems everything.

Right now I feel defeated. I’m tired from my pain medication. Food services couldn’t hear my order when I called, and eating is an exercise in futility anyway. It feels like the plan to slowly evaporate from my life is working.

Last night, however, when my boyfriend stopped in to see me, we came back to the topics of all the things we had yet to do. Tired of feeling sorry for myself, I found myself planning once more for little daytrips and concerts. I still want these things. I could still maybe have them in a month before I get sick yet again. When I think about the time I want to spend still with family and friends, slogging through a few more weeks of unending nausea and dehydration seem like I might be OK. I just talked to the team of doctors, and it looks like I have at least two weeks of antibiotics to clear up the infection.

When I’m not sad, I’m angry that my time of wellness is coming to an end and will sail on without me, awash in a sea of nausea, humiliation, fluid loss, weakness, pain. When the time comes and my VIPoma hormones soar again, I would like to just stop taking everything. I’ve thought about doing that sooner rather than later. I’m so tired.

But at other times, I’ll start booking things and planning things with en eye to knowing that I’ll probably end up right back here fairly soon and will continue to feel terrible. As for the pain, they’re going to send me home with pain medications for the times it feels like a shark is gnawing on my liver and for when the bones in my shoulder hurt.

What is a month? It’s four weeks I wouldn’t have had otherwise. Is it worth hanging on to this little bit? To these little tiny pieces of life? Even at my darkest times, I say yes.

After reading all the comments and messages,  I realized that if I could be physically cured by good thoughts, prayers, healing energy, and love, I would be done with cancer by now. If only things worked that way. But it’s not like all has been for naught: Kindness is a currency that has kept me afloat through six long and often disappointing years. It’s given me strength when I needed it and seen me through some dark times. It’s been especially illuminating this past year. For all the bad luck I’ve had healthwise, I’ve received good things tenfold back from my friends and can never feel unlucky in that respect, at least. Thank you all for reaching out.

I’m still pretty sick. They’ve balanced out my electrolytes pretty well and I’m currently getting a blood transfusion to boost my hemoglobin. I was hoping this would give me some goth cred, but I’ve always been too goofy to be a real goth. A friend recently who knew me in the early aughts declared me a “fashion goth.” I have to agree. Drinking blood=cute; eating souls=not cute. Velvet in winter=chic; leather in summer=too hot, just wear a band T-shirt. Anyway. I’m getting blood and my great-grandfather is from Transylvania so that’s cool enough for me.

I still haven’t had much relief from most of my other symptoms, and I’m hoping the end of antibiotics will help but I am losing hope. The treatment last time worked instantaneously. However, I asked about the uptake scan performed after yesterday’s procedure and it looks like uptake of the radioactive polypeptides. (A refresher: The tumors have somatostatin receptors, so radioactive peptides are injected into the blood. The tumors accept the gift from the bloodstream, but it’s a Trojan Horse, because then it delivers a high dose of radiation directly to the hormone-producing cell.)

Today I have been tired. I worked on things, and had several visitors, including a former stem-cell inmate, who brought me important periodicals! (And some strength from a strong cancer survivor.) My catgodmother stopped by on her way to stay with the cats, and several other friends stopped by with cookies, Goldfish crackers, and a Super Grover.

I have a lot of big decisions to make and a lot of things to wrap up, from how long I’d like to and could stay here in New York to rehoming the beloved cat trio.

I had a CT scan slated from 7-8 pm so I missed dinner. While I was awaiting my CT scan downstairs, however, I got a powerful liver cramp. My right clavicle started hurting as well. After the initial scans, there was a long pause, I expected the scan readers being so horrified by what was going on, they would stop and tell me, as I suspected, that my liver was exploding. Even pancreatitis hadn’t hurt this much.

They were just waiting for the IV nurse to inject contrast, as it turns out. “Are you seeing anything crazy?” I asked the CT person. After finishing the scan, I went back up to the room and that’s when the cramps started again in earnest. I called my new night nurse. By this time, I was gasping for air because the cramps hurt so much. As it became harder to breathe, I recognized the old symptoms of panic attack had arrived too. Just what I needed. So in addition to the cramps and shortness of breath, my face was inexplicably going numb and I couldn’t breathe. I explained I was now having pain and a panic attack, and the nurse turned on the oxygen to make me feel better as we waited. I hate dramatics, but shifted and whimpered. Everything hurt and on top of it all, I felt stupid with my completely unhelpful panic attack. I apologized and suggested Ativan.

After the Ativan and dilaudid, I slept.

Someone from the morning doctor team came in. There could be a spot where they embolized last week that’s super infected. The antibiotics at least are staving off further infection. I am here at least until Friday, maybe Saturday.

I know when I had cramps in my abdomen, pelvis, and shoulder, I’d hoped it was the pesky tumor-producing hormones dying. I wanted them to be accepting their peptides and explode and leave me alone. I haven’t seen much improvement after the PRRT, and I’m so disappointed. I’m hoping with all my might that it’s the antibiotics that are messing with my guts. Either way, it appears I need a bit of time to wrap up my life. Updates coming soon.

P.S. My room is freezing and the temperature drops by a degree every 12 hours. Facilities say they are looking into it, but it progressively gets colder, and I’m currently under about 10 thin blankets, which appears to be the solution right now. I’m hoping they move me to the private fancy floor if they can’t move me elsewhere. I’m so cold.

Aside from my body actively trying to kill me, everything else in my life has been going pretty well. I just need to stop dying. I’ve focused all of my energy on trying to get the last cycle of the PRRT treatment that helped me last time and had given me a year of wellness.

Throughout these past months, when it was clear the tumors were returning and spreading, I didn’t allow myself to think one thing: The PRRT might not work.

I have more tumors this time: They’ve spread beyond the pancreas. I was sicker going in this time. I don’t know. All I know is that I was feeling a bit better for a few hours, spiked a fever, was given antibiotics and now I’m almost back to where I was. My only hope is that it’s the antibiotics that are making me so sick, since taking IV antibiotics for my pneumonia last year landed me in the hospital for three days last November. I have a blood infection again, according to the tests. I hope I don’t have to get my MediPort taken out and then re-placed again.

My cancer is aggressive and it’s spreading and it’s doing its own thing. I have an extremely rare subset of cancer within a rare cancer. Most people get 30 months of relief with this treatment and the estimate for me was an accurate six. Yesterday, I clicked on a link posted by the Neuroendocrine Tumor Research Foundation about a dying young father who wrote a book for his son as part of his legacy. His tumors, too, didn’t act like they were supposed to act. He died at age 36 in December.

It was a feel-good story but it was also sad. I wonder sometimes if I’d rather have no story to tell. When I read Cutting for Stone by Abraham Verghese, this quote stuck with me: “’Another day in paradise’ was his inevitable pronouncement when he settled his head on his pillow. Now I understood what that meant: the uneventful day was a precious gift.”

I feel like I’ve made some sort of devil’s deal or a Monkey’s Paw deal where I’ll be happy for a year but the price is my life. I don’t remember this deal. I keep expecting an old crone to show up to remind me.

Still, I would have rather had this year than nothing. I just want more.

Yesterday I felt triumphant, and today I feel defeated. Yesterday I was planning on what to do with my few possible remaining months of wellness, and now I might not have them at all. Granted, a few months aren’t much either, but they were better than nothing, which is now could be what I am left with.

On Monday, I was too weak to make it into the office so I worked at home then took a Lyft to MSKCC in Brooklyn for fluids and bloodwork. Then I had to take a Lyft into an attorney’s office in Manhattan to sign something, a settlement of an old debt someone owes me. (So that is a good thing, plus I’ll have a tiny bit of cash coming in after my death either for the cats or for keeping my blog up for a bit.) On my way into the lawyer, I got the call from Sloan-Kettering: My electrolytes were too off for PRRT the next day, and could I come to urgent care?

And I’ve been here since. Yesterday they pumped me full of fluids and did the PRRT, my final dose, in an attempt to buy me a little bit more time. I was so happy. Very sleepy, but happy. My oncologist popped by to see me afterwards. This could cause bone marrow damage and I may not ever be 100% but I want to have a little bit more time.

This past year has been bittersweet, and I always know that when I see someone, it could be the last time. I’ve tried to visit my far-flung friends across the globe (Dublin, Copenhagen, Nashville, Los Angeles, Washington D.C.) and traveled with old and new friends (Cuba, Spain, Holland, France) and still barely made a dent. I made it to Ohio only once, to Cleveland. Columbus still holds too many memories. Most of them are good, but I’ve found myself unable to return. If I had more time… But I don’t.

When I was finally done with my fluids and a flurry of blood tests, I had my last PRRT. As a graduate, I got a “Fabulous” and superhero sticker. I finally did it and felt triumphant, even though all I did was beg and plead. I felt a little better, but then I had a temperature and I’ve been taking some antibiotics, and now I don’t feel much better. I’m still holding out some hope that stopping the antibiotics once this blood infection clears will help.

A lot of people came together to make this last treatment happen, and I’m extremely grateful. I think at the very least, it will help a little while I prepare for the very end. I’m grateful for all the research and hard work and kindness from Memorial Sloan-Kettering. They’ve kept me going for six years while my body has been actively trying to kill me through cancers. It’s been hard: chemo, radiation, stem cell transplant, Whipple procedure, ablation, embolizations, Mediports and PICC lines in and out. I’ve collected my own poop. I’ve coughed up pieces of my esophagus. To be free of this body will be a relief, but I’m not quite ready. Not quite.

Now I wait to see how the PRRT did and to clear the infection from my blood. All isn’t lost quite yet.

As I shuffled back from the bathroom to the room where I was being prepped for embolization, I heard my friend/former freelancer/catgodmother tell the nurse, “She means a lot to a lot of people, this one.”

A year ago, I remember crying in the same room as the doctors re-placed my MediPort after a blood infection. I’d felt abandoned, despite being surrounded by people. I burst into tears when they asked me who was picking me up. My new healthcare proxy picked me up that day, and she was there after this procedure too. We’d forgotten who I’d named my healthcare proxy, and I’d narrowed it down to three people. “I’ll use that to get in,” she said, adding she’d thought about telling the doctors she was my domestic partner or fiancee. But that position had already been taken. “I told everyone I was your fiancee,” whispered my boyfriend after I woke up from my procedure. “I didn’t know if they would let me in otherwise.”

From now on, I encourage everyone who visits to claim to be my fiancee and leave the hospital staff wondering.

I feel so different from a year ago. I had been surrounded by good people then too, but I had been alienated from the good for awhile.

I wish I didn’t feel so physically terrible. I’m back pretty much to where I was the January before last and the ensuing months, when I needed daily fluids. On Tuesday, I spent the night at urgent care for low electrolytes. I had been trying to wait until my IV fluids, but my heart had felt funny, and I was more lightheaded than usual, and I didn’t want to die at my desk, because not that many people sit around me and no one might notice until the web requests started piling up, unanswered.

On Monday, I got a call that I was slated for my last PRRT dose. (Through a spectacular misunderstanding on my part, I didn’t get it weeks ago, as I’d hoped. I also had to wait for insurance approval, which takes weeks.) “All I have to do is get through the next week,” I thought. It’s proven to be more difficult than I thought.

I also need to keep my platelets up, and they dropped after this embolization. The hope is that the embolization would relieve some of my symptoms, but so far, I feel worse. Part of it is because of post-embolization syndrome, which causes nausea and fatigue, and the other part is because I am on post-embolization antibiotics. Antibiotics tend to make me pretty sick, and I had to go to urgent care in November after a few doses.

If I can’t get the PRRT, then it’s just my time to go. I have to sign some legal paperwork on Monday and publish some calendar events for work and wrap up a freelance piece, but then I think I am free to go. I was hoping for a few months of wellness and some time to organize my affairs. But if it’s time, it’s time. I fought, off and on, for six years. I’m tired. I feel awful all the time. I’m ready to go if my platelets are too low for this last dose. I’ve had a good run.

As a writer much better than me once began a famous novel, “It was the best of times, it was the worst of times.” I don’t know much of the story beyond this, because A Tale of Two Cities is one of the few high school honors English required reading pieces I didn’t finish, even though I am a goodie-goodie. (Sorry, Charles Dickens.) I didn’t follow the stories of London and Paris during the French Revolution, but the book had a good opening line, and I feel like it has applied to my life the last year.

I have a picture of me from last July, smiling, floating lazily in a pool. Upon closer inspection, you can see that my pool float is actually a poop emoji. I feel like it was a visual representation of the time. I’d been going through a lot of crap and I was trying to stay afloat and upbeat. For the most part, I think I succeeded. By then, I had received PRRT and was feeling better than I had in months.

One year ago, they told me I had about a year of wellness left. I look back on that post and realize I couldn’t predict what was in store the next year. Last year, I seemed like a different person. I was so naive, in some ways. I was so worried about missing the Game of Thrones finale. How could I have known it would be so disappointing?

I had been hoping for more time, but almost exactly one year from my first PRRT, I started feeling sick again. My time is up. A year passed so quickly. When I had my first treatment, I felt like my life had been turned upside-down. I felt betrayed and alone and after months of being hooked up to IVs and feeling constantly sick and like a burden, I was ready to die.

Then I was given the gift of a year. At the time, I was in a haze, sad and defeated. Now that I’ve tasted life again, I want more time. Death is coming for me again, and I’m not ready. I recently tried a chemo drug that made me feel worse, and now, almost as a last-ditch effort, I’m getting one more round of PRRT, at a half-dose, now that my blood counts have finally come up a bit. I think it will buy me some months. And then, that’s it, I think.

The PRRT is slated for this Friday. I just have to stay alive and keep up with my potassium and pass my blood test tomorrow. Then, when (hopefully) I get the treatment, either: 1. nothing will happen, 2. my blood counts will drop and I’ll feel worse or 3. I’ll feel better. I need to feel better. The stakes are higher this time, because I want to live as much as I can while I can. And there’s nothing after this, it seems. It’s just a precipitous drop back into illness. I am scrabbling at the sides of this cliff. I’m clinging to the face of a rock with dirt-stained tear tracks on my face, begging for just at least a few more months, as my fingers lose their purchase and rocks pelt me from above.

People who love me are confident I have more time. I am less confident.

I find myself saying probably what most say when death comes. It could probably be engraved on most tombstones: Wait, I’m not done. I had more to do. I’m not ready. Just give me a little bit more time.

You can’t tell that I’m dying now, because I’m trying so hard to keep living. My mom recently visited for a week, and she said that she couldn’t tell I feel so sick.

I asked a year ago: What would you with one remaining year of life? I know the answer now, for myself. I tried to cram the rest of my life into it, the years, the decades I feel will be stolen. I worked. I wrote. I took a memoir-writing class. I resumed working out. I traveled: I went to Ireland, Denmark, Holland, France, Bermuda, Cuba, Spain, Los Angeles, Nashville, Cleveland, Washington D.C. I spent time with so many of my favorite people. I visited with friends, from Copenhagen to Dublin to L.A. to Nashville. So many friends visited me. My bathtub is lined with shampoo bottles from so many visitors.

I reconnected with people who had always been there for me and will always be there for me. When I went in for a scan recently, someone gave me a hug and reassured me, “You’re not alone.” I realized then that though I had started the year feeling abandoned and alone, I hadn’t really felt alone at all this past year, surrounded by so much love and support. I had felt lonelier and more isolated before this past year, as it turns out. I have been enveloped in goodness.

Along the way this past year, I met new people and made new friends. I fell in love.

I probably wouldn’t have done the last thing if I knew how limited my time was. Sometimes I get angry at myself for allowing myself to be optimistic, to hope that I had more than a year. I had started looking beyond my year, and then the curtains abruptly closed. It’s bittersweet.

This past year I healed, if not from the cancer, then from the inside. I hadn’t realized how broken I had become. It’s been one of the best years of my life. While I recovered from my first PRRT last June, as I watched Under the Tuscan Sun at more than an arm’s length from my friend whom I had to stay with while radioactive, I wondered aloud what to do. “I can’t be sad,” I said. “I have only a year. I don’t have time to be sad.” I couldn’t mope about the breakup. I couldn’t waste more time being angry, because I’d been angry for more than a decade already.

In February, I experienced a loss so devastating, I could barely get out of bed. But the clock was ticking, so I had to pick myself up, dust myself off, and keep going. If it would have been a physical manifestation of how I felt, I would have had teeth knocked out, bleeding, with a black eye, limbs askew. “I’m OK!” I reassure everyone, dragging myself forward.

I tried to find inner peace at meditation centers, in church pews, on yoga mats, in hypnotism. I allow myself to be sad, but I also don’t have time to wallow. I still find moments of peace. I watched the Fourth of July fireworks with some of my favorite people on a friend’s rooftop. Yesterday, I walked along the Brooklyn waterfront, the sky a sunset lavender behind the Statue of Liberty. I was heading back to my blanket to meet my friend and boyfriend on a beautiful summer night for an outdoor movie. I felt at peace.

I’m so happy. I’m also really sad. I’m scared for the possibility of disappointment that lies within the next few days and for the coming months.

On my last day in Málaga, as I got into an elevator to a rooftop terrace for a night view of the city, my phone rang. I recognized the Memorial Sloan-Kettering number, so I picked up. I was worried I’d forgotten about an appointment or some rest results. It was a nurse from my oncologist’s office, calling to see how I was doing.

“I’m in Spain!” I said. “Can I call next week when I get home?” I asked, mindful of the 25-cents-a-minute charge. The nurse sounded happily surprised I was on vacation.

A year ago, I constantly felt sick. I was miserable, physically and personally. I know that my time of feeling good is limited, and that it’s purchased in months and maybe years. Sometimes I try to do too much and I feel like I don’t give people in my life enough attention or that I run myself a little ragged. I want to savor everything and maybe it’s too much.

I’m on a flight home now. I live moment to moment, and I feel like I’ve forgotten everything about my life at home, especially after spending so much time with people I knew at other points in my life. I managed to truly relax, from the beaches of Málaga to a lazy Sunday in Copenhagen. On the first night in Málaga, I fell into such a deep sleep that I woke up not knowing where I was—or almost who I was. I call those nights a night of rebooting. It’s not like when you open your laptop and the screen appears, when you see the black and white type as the computer remembers everything.

One of the reasons I love to travel is it gives me perspective. I feel comforted that I’m just a tiny insignificant part of the world. It’s also why I love living in New York, one of nine million. Traveling opens my eyes to the vast world and everything seems possible.

Spain is so beautiful.

And yet: One night I came back to the Málaga apartment by myself as my friend popped out to look for something at the grocery store. I couldn’t get in our door. I’m bad with keys and doors. I actually try to avoid opening doors whenever I can, because I always open them the wrong way or don’t turn the handles enough and end up feeling silly. I then realized that the bathroom window was to the right. Ours is to the left. I’d been trying to get into the wrong apartment. I sheepishly retreated to the other door and hoped no one was home in the other apartment. “Wherever you go, there you are,” a friend reminded me.

It’s this reason that travel sometimes makes me melancholy. I don’t often travel by myself. In Cuba, traveling with a group of unfamiliar people, I wondered if I would feel isolated. But the group was warm and welcoming and I soon felt enveloped in their dynamic. I can’t spend too much time in my own head or with only myself. I enjoy spending some time by myself, but I also sometimes feel a bit panicked at being myself in a new environment. Maybe it’s disappointment at always being me. I have to confront who I am out of my normal context. And yet, on these recent trips, I didn’t have those feelings. Maybe I’m finally more comfortable with myself after four decades of existence.

Me bundled up on the Irish beach, while people behind me played volleyball in swimsuits.

I had an amazing trip. I feel like the Málaga part was the vacation, bookended by seeing friends in Dublin and Copenhagen. I was in Dublin for a day, where I went to the beach near my friends’ house and took a jet lag nap before leaving for Málaga the next morning. On the flight, I thought about what we called a European Friend Tour that happened almost exactly eight years ago: Dublin, then Copenhagen, then Prague, then Berlin, all to see friends.

I have wishing powers: Every now and then I wish for something and it happens. Deodorant, a jacket, a hair dryer, an ice cream sundae, and a glass of wine are just some of things that have materialized for me after wishing for them. I consider them gifts from the universe. I was a little bummed I wouldn’t get to see my Prague friends on this trip. As my friend and I settled into our apartment in Málaga, I got a message from one of the Prague friends, asking for recommendations of things to do in Copenhagen. Our trips would overlap by a day, and I saw them after all on my Saturday night in Denmark.

Me in my new dress after sitting in a puddle.

Spain is one of my favorite places, and I thought I would never see it again. As it is, it’s been more than a decade since I returned. I’d never been to Málaga; my friend took care of renting the apartment. I always mean to write a travelogue of my vacations but I never get around to it, so here it goes.

Within five minutes of exploring the city, I managed to sit in a puddle. Wherever you go, there you are. So I bought a cute dress as water seeped through my pants. We shopped and found the “cute wine bar by the church” that she had been to on her last visit, despite the proliferation of both in the old town. We walked around through the Soho area and down by the Ferris wheel, then back to the old part of the city.

The next day, we went to the Van Gogh Alive interactive touring art experience. It was unseasonably chilly for most of my time in Spain, and the person at the desk asked if I was a student, I think because I had the hood of my hoodie up and looked particularly youthful. My friend laughed. Being mistaken for a student was worth the price of admission already. I was a little skeptical of an interactive exhibition, but I was surprised at the effect Vincent Van Gogh’s words, paired with his paintings, had on me. I’d been to the Van Gogh Museum in Amsterdam, but I felt like this gave me a deeper understanding of him, as a person and an artist. I found myself truly moved, maybe because I’m more of a words person. “We spend our whole lives in unconscious exercise of the art of expressing our thoughts with the help of words,” he wrote.

He also wrote about comfort of arts: “In painting I want to say something comforting in the way that music is comforting.” And I took some of his words as comfort for cancer: “Only when I fall do I get up again.” And this also resonated, after this particularly tough few years: “But it is possible that everything will get better after it has all seemed to go wrong. I am not counting on it, it may never happen.”

After the Van Gogh exhibition, we went to the nearby Centre Pompidou Málaga. Somehow, ever since we were in high school, we decided we would one day become shepherdesses in Europe. We drew sheep on our notebooks. One year, she dressed as a shepherdess for Halloween, and me and another friend were her sheep. We spent hours poring over books at a bookshop, planning a future Europe trip. We kind of did it in 2011 in Dublin and in Berlin during the European Friend Tour, but we never really set out, just the two of us. As we entered the Pompidou, we saw a large flock of fluffy wooden sheep on wheels.

Finally, it was happening. It’s as if everything had been leading up to this point. Our dreams were realized.

So happy.

After taking in the museum exhibitions, we went to have an early dinner/late lunch. As I sat nestled next to a fire awaiting my paella, which I’ve decided is one of my all-time favorite foods, I handed my friend my phone. “Take a picture!” I said. “I’m so happy.”

Afterwards, we got frozen yogurt. I ordered all in Spanish and with three toppings and declared myself fluent and probably able to live in Málaga.

Then we attempted to climb the steep incline to the castle at the top of the city. I was too tired and had to rest very often.

With my new haircut!

Every now and then, cancer reminds me of its presence. I overheard my ex say, after we broke up, “I had fun walking around London by myself not thinking about cancer.” At the time, I was hooked up to IVs for four hours a day and had a PICC line in my arm, so I never had a break from cancer. But now I too can enjoy walking around Europe not thinking about cancer.

For the most part.

After a good night’s rest, I was ready to go to Cordoba the next day, but the train schedule was confusing and the tickets were more expensive than we anticipated, so we opted to see La Colección del Museo Ruso de San Petersburgo, Málaga, an outpost of the St. Petersburg art museum, housed in an old cigar factory. We got lunch on the walk, along the beach, and I watched fish and sardines cooked on skewers outside. I ate a whole fish.

By the time we got back to the old part of the city, the cathedral was closed but I’d spotted a barber that specialized in both men’s and women’s haircuts and I wanted to get my hair fixed. I usually go to a guy with a barber chair in a shoe repair shop near work, but we had some miscommunication this time, and my hair was weird. But maybe the key is not talking too much. After I explained that I didn’t speak too much Spanish, I tried to convey that I wanted the back cleaned up and I want it longer on top, eventually. She said she couldn’t make it longer. But she cleaned up the sides so that when it grows in, it will look like what I’m picturing. And it was 20 euros, a cut that would easily cost at least $50 in New York.

We took my new haircut to the castle steps, and finally reached the very top, which was closed. But we got some good photos of the city. At the Mexican restaurant for dinner, the tacos were 7 euros. Again used to NYC prices, I asked my friend uncertainly, “Per taco?” It turns out they were the tiny gourmet style soft corn tortilla tacos.

In my orange tree shorts reaching for an orange.

On my final day in Málaga, I had to visit the Museo Picasso Málaga, where my museum ID wasn’t accepted. (It’s usually the case in Europe but it had worked in a few museums so I was hopeful.) I particularly liked the room that showcased his love of animals and the Olga Picasso exhibition, which showed how her portrayal in Picasso’s paintings changed as their relationship dissolved.

So beautiful, it’s ridiculous.

It was finally sunny and warm, so we took the bus to nearby Nerja, along the Costa del Sol. Since I was trying to pack light, I didn’t bring my usual beach towel with my name embroidered on it, so I’m now the owner of a red and black España beach towel. From the Balcony of Europe, we took photos of the beautiful Mediterranean blue. It was ridiculously beautiful, ringed by mountains. The beach itself was a bit gravely, and the water itself was a little cold—I thought it was OK initially but I realized my legs had gone numb—but laying out in a bathing suit in the warm sun was perfect. “What should we do now?” my friend asked after about an hour. “Isn’t this it?” Even as the temperature cooled, it was hard to drag myself away from the beach to catch the bus back to Málaga.

Can’t talk to the oncologist’s office because I’m on a rooftop in Spain!

We tried to visit the cathedral again and it was closed, so we ended up at a restaurant called Clandestino, tucked away a tiny bit from the bustling Friday night Malaga streets before visiting the rooftop to take in one more view of Malaga at night.

So happy to spend time with some of my favorite expats!

In the morning, we tried to visit the cathedral again, but the hours on Google were wrong. Then I went to Copenhagen, where I watched a street party from my friend’s balcony before meeting up with the Prague friends for dinner at Baest. The following day was a lazy Sunday of walking around, getting pastry and finally getting a Danish hot dog, something I’ve thought about since my last one eight years ago. I tried to send postcards, but it would have been the equivalent of $5 each to send them so I’ll mail them from the post office near my office. I ate one more hot dog at the airport.

Hot dogs are in my top five favorite foods. I love Danish hot dogs.

That brings me to now, on a flight from Stockholm to New York. Home. Sometimes I can’t believe that New York is my home. Within the next month, I have friends in town and a trip to Nashville planned. I’ll be celebrating a year of independence. I love New York in the summer: the street fairs, the beach (not quite the Mediterranean or the pink shores of Bermuda, but I’ll take it), free outdoor activities.

Vacation is over, but I still have so many adventures ahead of me, I hope.

Today—or is it yesterday by now?—I briefly had the post-visitor blahs, that feeling you get when visitors leave and you actively feel their absence. My friends from DC, one of whom I met in a Dunkin’ Donuts parking lot when I was 16 years old, were in New York last night to play a show. I used to see their band all the time when we all lived in Columbus, Ohio. I see them often enough now where I gave them keys to my apartment with a keychain that says “Best Couple Ever.”

I had my blahs only for about 15 minutes, after I handed off the keys to the friend of a friend who is staying in my apartment for the next few days and left to go exploring and I finished packing. It’s my turn to be the visitor now. I’m headed to Dublin as I type, to see my best friend. She’s lived in Ireland since right after college and did grad school there.

It’s so different from the first time I visited, when I was 22. My heart had been broken, and I decided on a whim to visit her. I booked a trip on Expedia and when I went to call call her, I learned she and some other long-term residents had been asked to moved from the hostel where she was staying. She hadn’t told me, I found out later, because her mom regularly called me for updates, and I am a terrible liar. She didn’t want her mom to worry as to her whereabouts. (And her mom had been calling me, wondering where she was.)

So I found myself with tickets to Ireland and no way to contact her, until I remembered the name of the pub where she worked. I rushed home from work to use my landline for long distance. The bartender answered. I said I was looking for my friend, but he replied she wasn’t in yet. “OK,” I said. “Can you give her a message for me? Can you tell her Josie is coming to visit next week?”

“Right, Josie’s coming,” he said.

“Oh, can you also tell her to call her mom?” I asked.

He laughed.

“Have you not been calling your mother?” the bartender scolded her when she arrived to work. “Oh, and Josie’s coming next week.”

These tickets were booked not too long ago. I didn’t have a return flight for a few days. I would say cancer makes me more impulsive now, but only a little bit. It more or less gives me the excuse to be more myself.

I’ve mentioned this before but there are pretty much high highs and low lows with my life for the past few years. The past few weeks have been weird. One of my cats has been sick. Last week looked grim, but he’s responding to medication. Still, for a few days before I left, he wasn’t quite out of the woods. I made the decision to board him at the vet, where they can straighten out his medications and keep an eye on him. It’s the right decision but my heart broke this morning as he curled up around my neck and purred and put a soft paw on each side of my face, blissfully unaware of my impending departure. When I corralled him into his carrier, one of the other cats sat on his carrier as if to keep me from taking his buddy. It was a moment of solidarity, an “I am Spartacus” moment.

While at the vet saying goodbye to him, I was sad to leave the cat but excited to see my friend and her family in Dublin. From there we’re going to Spain, one of my favorite places in the entire world. I’ve been there when I was four, when I was 16, and in my 20s, and I’ve always vowed to go back.

Then I’m going to pop over to Copenhagen for barely two days to see one of my friends. I met him on a street corner in downtown Columbus years ago. I had actually seen him in my apartment at least once before, when I lived with a mutual friend, so his face was vaguely familiar, but we ended up living in the same neighborhood and working near each other so I would see him at the grocery store and on the bus, sometimes giving him a hey-we-kind-of-know-each-other nod of acknowledgement. I had forgotten my gym shoes that day and was walking home early. As I neared a street corner, our paths intersected. “Who are you?” he asked me. “I see you everywhere.” We walked back to our neighborhood together and have been friends ever since.

I try to do so much and I feel like everything is a whirlwind. This time on the plane is full of stolen moments. I watched a whole movie without doing anything else. I am catching up on writing.

Today—it’s definitely yesterday now—I opened the carrier and kissed my cat’s nose and promised to be back soon. I wish sometimes that all the beings I like and love lived in the same place, but that’s not how it is. I lived in Ohio for so long but people moved away, then I moved to New York, and then people left from New York. My heart aches sometimes when I have to say goodbye to people again and again, but I know I am lucky to have so many people I care about and so many people who care about me, spread throughout the globe.

I keep also making new friends, and for that I am also grateful. Without the spreading out of my favorite people, I wouldn’t have more adventures. I wouldn’t be on a flight to Dublin or visiting Copenhagen. I wouldn’t be going to Nashville next month. I wouldn’t have some people who live in Louisiana who I met in Cuba earlier this year staying with me. I wouldn’t have a riot grrl weekend of back-to-back L7 and Bikini Kill shows with high school friends visiting me next month.

I wouldn’t feel the bittersweet feeling of leaving my cats with the excitement of a vacation. I’m also grateful that when it’s time to return home, it’s to my favorite place in the entire world.